Anizokoriya – oftalmosindry, shown the different diameter of the right and left pupil. It is observed at a number of eye and neurologic diseases. The expressed changes are followed by disorder of spatial perception, distortion of the considered image, the increased visual fatigue. Diagnostics includes studying of features of reaction of pupils, eye biomicroscopy, a diafanoskopiya, a research with M-holinomimetikami. Tactics of treatment is defined by the main pathology. At injuries of an eye operation is shown, at damage nervous – neurostimulation. At an inflammation of an iris use antibacterial means and NPVP.
Anizokoriya – the important diagnostic criterion in ophthalmology demonstrating direct damage of an organ of vision or existence of neurologic frustration. Statistical data on prevalence of this state are absent. Pathology can meet at any age, however similar defects arise at young people more often. At children's age the long anizokoriya in 34% of cases involves development of secondary complications in the form of anomalies of a refraction. The ratio of women and men with this violation makes – 2:1. It is connected with the fact that female persons have a tonic pupil of Adie much more often.
Unevenness of the sizes of pupils meets rather often, however the reason of this state manages to be established not always therefore some cases carry to an idiopathic form. Similar violations can be a symptom of both organic defects of covers of an eye, and the dysfunction connected with pathology of the autonomic nervous system. Are the main reasons for development of an anizokoriya:
- Use of medicines. At unilateral instillation M-holinolitikov or M-holinomimetikov the pupil size for a while changes. Similar frustration remain until removal of medicine from an organism or before introduction of antagonists of medicines.
- Horner's syndrome. At an okulosimpatichesky syndrome the ophthalmologic symptomatology arises again against the background of other diseases. The central, post-or preganglionarny damage of sympathetic nervous fibers is the cornerstone of pathology.
- Irit. At an inflammation of an iris of the eye of an eyeball the pupillary opening on the party of defeat is narrowed. As a rule, clinical manifestations are leveled after application of NPVS. At formation of sinekhiya between pupillary edge and a forward surface of a crystalline lens the anizokoriya remains a long time.
- Syndrome Argayl Robertson. Specific infection of eyes at neurosyphilis is the cornerstone of this phenomenon, is more rare – diabetic neuropathy. Feature of a state consists in preservation of ability of pupils to accommodation in the absence of reaction to lighting differences.
- Syndrome Holmes-Adie. At this neurologic frustration monotonous expansion of a pupil in combination with the slowed-down reaction to light is observed. Akkomodatsionny ability is characterized as bright close dissociation that in the described case is paradoxical.
- Traumatic damages. Malfunction of a dilatator or a sphincter of a pupil is quite often caused by a rupture of pupillary edge of an iris to which lead the getting eyeball wounds. Anizokoriya can be a consequence of formation of peripheral slit-like defects of an iris.
- Paralysis of a glazodvigatelny nerve. At damage of the III pair of cranial nerves pathology of a pupil is followed ptozy and a total atoniya of external muscles of an eyeball. Application of holinergichesky means in average and high dosages is capable of time to change parameters of a pupillary opening.
Unilateral application M-holinolitikov leads to temporary blocking M-holinoretseptorov of the parasympathetic nervous terminations that exponentiates expansion of pupils. M-holinomimetiki have opposite effect as play a mediator role. Normal acetylcholine, interacting with the receptor device, leads to narrowing of a pupillary opening. Expressiveness of a tsiliospinalny reflex at Horner's syndrome decreases because of direct damage of sympathetic nerves. At violation of transfer of a neuromuscular impulse on a glazodvigatelny nerve the sphincter and a dilatator of a pupil do not function.
The complete separation of a sphincter leads to total expansion of a pupillary opening. When traumatizing a dilatator the pupil is narrowed because of preservation of function of a muscle antagonist. Lead organic defects of an iris to development of an anizokoriya. The muscles which are responsible for change of diameter of a pupil pass in more thickly iris of the eye therefore an inflammation, defects or anomalies of a structure become a cause of infringement of their functions. The similar picture is observed at infections with penetration of a virus into covers of forward department of an eyeball. The long course of inflammatory process provokes formation of dense soyedinitelnotkanny unions which interfere with normal operation of the akkomodatsionny device.
All defeats of a pupillary opening can conditionally be divided on congenital and acquired. The variable sizes of a pupil happen resistant and passing, at intermittiruyushchy option diameter is restored after completion of influence of a trigger factor, at resistant – remains for a long time. Distinguish two main forms of pathology:
- Physiological. Quite often occurs at healthy people, it is traced at rest. The difference in the diameter of pupils does not exceed 1 mm. Visual differences at a rate of a pupillary opening remain regardless of features of lighting.
- Pathological. This form of an anizokoriya is a symptom of a neurologic or ophthalmologic disease. The difference of pupils varies over a wide range. The interrelation between the size of a pupil and reaction of an eye to change of intensity of lighting is noted.
At an insignificant difference of diameter of pupils the only symptom is cosmetic defect. At the expressed anizokoriya there are complaints to distortion of the image before eyes, violation of spatial perception. Dizziness and a severe headache which only for a short time manages to be stopped reception of analgetics develops. Visual loading (work at the computer, reading books, viewing of the TV) is followed by increased fatigue. At the sharp movements of eyeballs the general state worsens. Visual acuity does not decrease, at a syndrome Holmes-Adie perhaps zatumanivany sight.
The clinical picture in many respects depends on the main pathology. At Bernard-Horner's syndrome the symptomatology is most expressed at the low level of illumination, especially in the first several seconds. On the struck party sweating is broken, the iris looks lighter. At the isolated paralysis of a glazodvigatelny nerve besides an anizokoriya there is a diplopiya, a pain syndrome, difficulty of a smykaniye of a century. At patients with pathology of a parasympathetic innervation the size of pupils differs only at bright light, photophobia is traced.
Eye migraine is considered the most frequent complication of an anizokoriya. Lack of reaction of one of pupils to differences of brightness of lighting and uneven hit of light on a retina are a cause of infringement of visual perception. The accommodation spasm which imitates a clinical picture of a miopiya is observed. Patients can have secondary uveit. Jet changes from a disk of an optic nerve are found very seldom. Patients try to limit participation of one eye in the act of sight therefore over time the symptomatology of a false ptoz of an upper eyelid progresses. Children have a high risk of development of an ambliopiya.
Diagnosis is based on results of objective inspection and anamnestichesky data. In the course of inspection exclude traumatic injuries of eyes, syphilis and application of eye drops. At survey find out at what pupil there are pathological changes. The main methods of diagnostics include:
- Studying of reaction of pupils to light. In case of a physiological anizokoriya the test result corresponds to average indicators. At pathological process the pupil reacts to light inertly, at permanent morphological changes reaction is absent.
- Eye biomicroscopy. Survey of a forward segment of an eyeball by means of a slot-hole lamp gives the chance to visualize organic defeats. At an anizokoriya traumatic damages of an iris of the eye, a sphincter or a dilatator of a pupil come to light.
- Diafanoskopiya. By means of a diafanoskopa-transwindow diagnostic raying of tissues of eye is carried out by a source of the passing light. A research objective – to find slit-like defects of transillumination on the periphery of an iris.
- The test with M-holinomimetikom. For carrying out a research usually use pilocarpine a hydrochloride. Hypersensitivity of an iris to low concentration of medicine allows to assume that Adie's pupil is the cornerstone of an anizokoriya.
Treatment of an anizokoriya
Tactics of treatment depends on a disease etiology. At okulosimpatichesky simptomokompleks it is possible to eliminate an anizokoriya by means of neurostimulation or replacement therapy with hormonal medicines. If necessary carry out surgical correction of a ptoz, a section of back sinekhiya. If narrowing of a pupil is caused by Irit, include nonsteroid anti-inflammatory and antibacterial means in a complex of treatment. At a tonic pupil of Adie it is possible to level anizokoriya symptomatology by instillations M-holinomimetikov. At syphilis of eyes specific antibacterial therapy is shown.
Forecast and prevention
The forecast is defined by the reason of development of this state. At a physiological anizokoriya all changes have the passing character. In case of organic defeat of nervous fibers a failure as akkomodatsionny ability of a pupil hard gives in to correction. After the postponed paralysis of a glazodvigatelny nerve the lost functions in case of a favorable outcome are restored within 3 months. Specific preventive measures are not developed. Nonspecific prevention comes down to rational use of medicines for instillations in a conjunctiva cavity, to timely treatment of an inflammation of an iris, use of individual protection equipment for the purpose of the prevention of a travmatization of eyes.